Clinical and Epidemiological Characteristics of Patients with Dientamoeba fragilis Infection

Lucía Miguel Department of Infectious Diseases, Vall d’Hebron University Hospital, Universitat Autónoma de Barcelona, PROSICS Barcelona, Barcelona, Spain;

Search for other papers by Lucía Miguel in
Current site
Google Scholar
PubMed
Close
,
Fernando Salvador Department of Infectious Diseases, Vall d’Hebron University Hospital, Universitat Autónoma de Barcelona, PROSICS Barcelona, Barcelona, Spain;

Search for other papers by Fernando Salvador in
Current site
Google Scholar
PubMed
Close
,
Elena Sulleiro Department of Microbiology, Vall d’Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain

Search for other papers by Elena Sulleiro in
Current site
Google Scholar
PubMed
Close
,
Adrián Sánchez-Montalvá Department of Infectious Diseases, Vall d’Hebron University Hospital, Universitat Autónoma de Barcelona, PROSICS Barcelona, Barcelona, Spain;

Search for other papers by Adrián Sánchez-Montalvá in
Current site
Google Scholar
PubMed
Close
,
Daniel Molina-Morant Department of Infectious Diseases, Vall d’Hebron University Hospital, Universitat Autónoma de Barcelona, PROSICS Barcelona, Barcelona, Spain;

Search for other papers by Daniel Molina-Morant in
Current site
Google Scholar
PubMed
Close
,
Isabel López Department of Microbiology, Vall d’Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain

Search for other papers by Isabel López in
Current site
Google Scholar
PubMed
Close
, and
Israel Molina Department of Infectious Diseases, Vall d’Hebron University Hospital, Universitat Autónoma de Barcelona, PROSICS Barcelona, Barcelona, Spain;

Search for other papers by Israel Molina in
Current site
Google Scholar
PubMed
Close
Restricted access

Dientamoeba fragilis is an intestinal protozoan, usually considered nonpathogenic. However, in the last years, there has been an attempt to clarify its possible pathogenic role. We aim to evaluate the clinical and epidemiological characteristics of D. fragilis–infected patients. Adults with D. fragilis detection in feces who attended the Vall d’Hebron University Hospital (Barcelona, Spain) were evaluated retrospectively from April 2009 to March 2014. We classified the patients in asymptomatic, symptomatic without other causes except infection of D. fragilis, and symptomatic with another cause. Among symptomatic patients, treatment response was evaluated. One hundred eight patients were included. Sixty-three percent of the patients were immigrants, 29.6% were autochthonous, and 7.4% were travelers. Forty-nine (45.3%) patients presented symptoms, and eosinophilia was observed in 26 (24.1%) patients. Overall, 59 (54.7%) patients were asymptomatic, 15 (13.8%) presented symptoms which were attributable to other causes, and 34 (31.5%) patients presented symptoms with no other causes. In this last group, 29 patients received specific treatment and 65.5% of them presented a complete resolution of the symptoms. The group of symptomatic patients with no other cause had more proportion of women, more proportion of autochthonous people, and were older compared with the group of asymptomatic patients. Dientamoeba fragilis infection should be considered as pathogenic when other causes are ruled out.

Author Notes

Address correspondence to Fernando Salvador, Infectious Diseases Department, Vall d’Hebron University Hospital, P° Vall d’Hebron 119-129, Barcelona 08035, Spain. E-mail: fmsalvad@vhebron.net

Authors’ addresses: Lucía Miguel, Fernando Salvador, Adrián Sánchez-Montalvá, Daniel Molina-Morant, and Israel Molina, Department of Infectious Diseases, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, PROSICS Barcelona, Barcelona, Spain, E-mails: lucy_zgz86@hotmail.com, fmsalvad@vhebron.net, adsanche@vhebron.net, dani.molina7@gmail.com, and imolina@vhebron.net. Elena Sulleiro and Isabel López, Department of Microbiology, Vall d’Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain, E-mails: esulleir@vhebron.net and maibel56@gmail.com.

  • 1.

    Cacciò SM et al. 2016. Multilocus sequence typing of Dientamoeba fragilis identified a major clone with widespread geographical distribution. Int J Parasitol 46: 793798.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    Norberg A, Nord CE, Evengard B, 2003. Dientamoeba fragilis a protozoan infection which may cause severe bowel distress. Clin Microbiol Infect 9: 6568.

  • 3.

    Stark D, García LS, Barratt JL, Phillips O, Roberts T, Marriott D, Harkness J, Ellis JT, 2014. Description of Dientamoeba fragilis cyst and precystic forms from human samples. J Clin Microbiol 52: 26802683.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Windsor JJ, Johnson EH, 1998. Dientamoeba fragilis: the unflagelated flagellate. Br J Biomed Sci 55: 172175.

  • 5.

    Johnson EH, Windsor JJ, Clark C, 2004. Emerging from obscurity: biological, clinical, and diagnostic aspects of Dientamoeba fragilis. Clin Microbiol Rev 17: 553570.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Stark D, Barratt J, Chan D, Ellis JT, 2016. Dientamoeba fragilis, the neglected trichomonad of the human bowel. Clin Microbiol Rev 29: 553580.

  • 7.

    Ockert G, Schmidt T, 1976. Evidence of Dientamoeba fragilis in Enterobius eggs using isoelectric point determination. J Hyg Epidemiol Microbiol Immunol 20: 7681.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Boga JA, Rojo S, Fernández J, Rodríguez M, Iglesias C, Martínez-Camblor P, Vázquez F, Rodríguez-Guardado A, 2016. Is the treatment of Enterobius vermicularis co-infection necessary to eradicate Dientamoeba fragilis infection? Int J Infect Dis 49: 5961.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Stark D, Barratt J, Roberts T, Marriott D, Harkness J, Ellis J, 2010. A review of the clinical presentation of dientamoebiasis. Am J Trop Med Hyg 82: 614619.

  • 10.

    Stark D, Beebe N, Marriott D, Ellis J, Harkness J, 2005. Prospective study of the prevalence, genotyping, and clinical relevance of Dientamoeba fragilis infections in an Australian population. J Clin Microbiol 43: 27182723.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Munasinghe VS, Vella GN, Ellis JT, Windsor PA, Stark D, 2013. Cyst formation and faecal–oral transmission of Dientamoeba fragilis–the missing link in the life cycle of an emerging pathogen. Int J Parasitol 43: 879883.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Holtman GA, Kranenberg JJ, Blanker MH, Ott A, Lisman-van Leeuwen Y, Berger MY, 2017. Dientamoeba fragilis colonization is not associated with gastrointestinal symptoms in children at primary care level. Fam Pract 34: 2529.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Nagata N, Marriott D, Harkness J, Ellis JT, Stark D, 2012. Current treatment options for Dientamoeba fragilis infections. Int J Parasitol Drugs Drug Resist 2: 204215.

  • 14.

    Garcia LS, 2016. Dientamoeba fragilis, one of the neglected intestinal protozoa. J Clin Microbiol 54: 22432250.

  • 15.

    Engsbro AL, Stensvold CR, Nielsen HV, Bytzer P, 2012. Treatment of Dientamoeba fragilis in patients with irritable bowel syndrome. Am J Trop Med Hyg 87: 10461052.

Past two years Past Year Past 30 Days
Abstract Views 980 804 261
Full Text Views 743 18 6
PDF Downloads 285 11 2
 

 

 

 
 
Affiliate Membership Banner
 
 
Research for Health Information Banner
 
 
CLOCKSS
 
 
 
Society Publishers Coalition Banner
Save